Non-Radical Diagnostic Biopsies Do Not Negatively Influence Melanoma Patient Survival

Abstract

Background: In fair-skinned Caucasian populations both the incidence and mortality rates of cutaneous melanoma have been increasing over the past decades. With adjuvant therapies still being under investigation, early detection is the only way to improve melanoma patient survival. The influence of incisional biopsies on melanoma patient survival has been discussed for many years. This study investigates both the influence of diagnostic biopsy type and the presence of residual tumor cells in the re-excision specimen on disease free and overall survival.Methods: After (partial) removal of a pigmented skin lesion 471 patients were diagnosed with stage I/II melanoma and underwent re-excision and a sentinel node biopsy. All patients were followed prospectively, mean follow up >5 years. Patients were divided according to their diagnostic biopsy type (wide excision biopsy, narrow excision biopsy, excision biopsy with positive margins and incisional biopsy) and the presence of residual tumor cells in their re-excision specimen. Survival analysis was done using CoxÕs proportional hazard model adjusted for eight important confounders of melanoma patient survival.Results: The diagnostic biopsy was wide in 279 patients, narrow in 109 patients, 52 patients underwent an excision biopsy with positive margins and 31 patients an incisional biopsy. In 41 patients residual tumor cells were present in the re-excision specimen. Both the diagnostic biopsy type and the presence of tumor cells in the re-excision specimen did not influence disease free and overall survival of melanoma patients.Conclusions: Non-radical diagnostic biopsies do not negatively influence melanoma patient survival.

Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

“…A properly performed deep scallop shave biopsy can be very accurate in sampling a melanoma and determining the lesion’s true depth. 11,12 The main disadvantages of a shave biopsy are cosmetic (lack of sutured closure may result in depressed, hypo- or hyperpigmented scarring) and the potential for the lesion to be partially sampled if its base is transected. In this series, a positive deep margin was found in 37% of all patients, but in only 21.8% of patients suspected of having melanoma before diagnostic shave biopsy.…”

Skin Melanomas Excised by General Practitioners: More Often Unsuspected, of Nodular Type and Less of Often Radically Excised Than Those Excised in an Academic Setting

“…A low index of suspicion will usually lead to a narrow primary excision with a higher risk of irradicality. Although some studies suggest that a primary irradical excision may not influence prognosis [10,11], the general consensus is to refer pigmented lesions with a high index of suspicion to a dermatologist or surgeon for a slightly wider local excision followed by re-excision and sentinel node biopsy [12,13] if indicated. The very fact that such patients are referred leads to an enriched "suspicious" population of lesions for which the academic specialists would inherently more often do more a slightly wider local excision, could also contribute to the higher rate of academic radical excisions.…”

“…Our own studies [3,4] showed that 1.9% of pigmented skin lesions submitted for histopathology bared a (pre) malignancy, 62% of the malignancies being an unsuspected melanoma. Although it has not convincingly been proven that (incisional) biopsies of melanomas worsen prognosis [8], best practice for a GP is yet to radically excise suspicious lesions whenever possible or refer to a dermatologist or surgeon. Therefore, proper assessment of the index of suspicion by GPs would result in optimal care for patients with pigmented lesions: primary excision followed by sentinel node biopsy if indicated for patients with a high index of suspicion by dedicated specialists (surgeons or dermatologists), and narrow excision with good cosmetic outcome by GPs of lesions with a low index of suspicion.…”

Biopsy of the pigmented lesion—When and how

“…Shave biopsy is by far the most common technique employed because of its rapidity and low cost as well as ease of wound care and an optimal cosmetic result. 32,[80][81][82][83] Another utility of the tangential technique is to allow for broad sampling of the lesion in question as opposed to incisional methods. A superficial shave removes mostly epidermis and at times superficial dermis.…”